Important Information to Know when Processing Community Alternatives Program (CAP) Claims

Requirement: Ordering, Prescribing, Rendering and Referring Providers National Provider Identified (NPI) must be included in the claim.

Federal Regulation 42 CFR 42 455.410 requires the ordering, prescribing, referring, or rendering physician or practitioner to be enrolled to provide Medicaid services in North Carolina. Claims submitted for home and community-based services must include the ordering, prescribing, referring, or rendering physician or practitioner National Provider Identifier (NPI) number on the claim per CFR 455.440. Specific to CAP, the ordering and referring provider NPI are required on submitted claims. The ordering and referring NPI must be an individual, not an organization or group. For additional information about the ordering, prescribing, referring, and rendering provider, click the links below:

OPR Fact Sheet

The 'Submitting a Professional Claim Participant User Guide' can be found under Claims Submission on the User Guides and Fact Sheets page. Refer to page 26 of the guide under Additional Information in the claim form.